The Pandemic Planners Were Ready. No One Listened.
The
Covid-19 pandemic has laid bare many fault lines in American society, from the
savage inequalities of our health care system to the collapse of federal
governance into a quagmire of blame-shifting and conspiracy-mongering during
much of the crisis. For longtime financial journalist Michael Lewis, though,
the effort to comprehend and contain the spread of Covid-19 mostly represents a
tragic parable of unheeded expertise and thwarted procedural efficiency. Lewis’s
new book on the Covid debacle, The Premonition, is a companion study of
sorts to his 2018 book The Fifth Risk, which sought to document the
heroic resistance to the raw dictates of Trumpism mounted by conscientious
civil servants ensconced in the federal bureaucracy. As in that book, The
Premonition renders the crisis of the moment as a long-gestating case study
in the misallocation of policy imagination. In this case, the challenge of the
pandemic summons a corps of policy entrepreneurs, both within and without the
public sector, to act as an ad hoc sort of Justice League, managing by force of
invention and stubborn will to steer the errant machinery of governmental power
back toward the path of sane public health planning and long-term Covid
containment. If only their counsel had commanded brisk assent in the early
phases of the pandemic, the great narrative moral of The Premonition has
it, untold thousands of lives would be saved.As
a diagnostic saga, the narrative of The Premonition makes for compelling
reading, as Lewis’s corps of lead administrators and investigators stumble into
the vanguard of American pandemic planning and doggedly thrash out
and refine their new, prevention-driven model of containment and (eventual)
treatment. Lewis writes of the quest for an improved public health response to
such devastating crises as an extended set piece in fearless and iconoclastic
scientific inquiry, calling to mind the tense, high-stakes storyline of a
Michael Crichton thriller or an episode of House.But
for all the genuinely heroic determination and bold thinking displayed by the
lead characters in The Premonition, the American Covid catastrophe has proved
to be something more than a lesson in the superior brief of policy innovation and
enlightened data science. Many of the failures of our country’s Covid response ultimately
stemmed from the dogmatic refusal to believe that government can and should
envision and carry out a comprehensive plan to preserve our public health in
the first place. Yet rather than confronting the ideological proportions of
the crisis, the otherwise restless, skeptical corps of lead characters in The
Premonition leap into the same privatizing logic that has wreaked so much
harm in American health care. Going
back to his landmark first book on Wall Street’s characteristic 1980s excesses,
Liar’s Poker, Lewis is a lively narrator of the folkways and unintended
consequences of elite systems management and has a knack for chronicling the
struggles of heterodox thinkers seeking to muscle their way into the center of
the action. This was the morality play that propelled his best-known work, Moneyball
(2003), which chronicled the data-analytics revolution in Major League
Baseball, and it also fuels nearly all the central conflicts in The
Premonition. As the title suggests, a scattered company of data and policy
visionaries stumble upon the challenge of plotting out future pandemic
scenarios and discover that American leaders have done astonishingly little to
think through the basic demands of crisis management during such emergencies,
or to prepare for the sacrifices entailed by effective pandemic containment
strategies.Lewis writes of the quest for an improved public health response as an extended set piece in fearless and iconoclastic
scientific inquiry, calling to mind the tense, high-stakes storyline of a
Michael Crichton thriller or an episode of House.These
figures start out on discrete paths through various, dubiously hospitable
thickets of institutional groupthink toward their eventual shared mission. Back
in 2004, Bob Glass, a scientist at Sandia National Laboratories in New Mexico, was drawn into the exercise of data-modeling a new pandemic’s patterns of social
transmission through a science-fair project his daughter completed at her
Albuquerque middle school; eventually he enlisted a computer whiz at Sandia to
help flesh it out. Charity Dean, who worked as a public health officer in Santa
Barbara, California, from 2011 to 2018, confronted local outbreaks of
tuberculosis and meningitis B—together with the gruesome, disease-ridden
detritus of a major fire and mudslide—before moving into the number two spot in
the state public health administration in Sacramento. Lisa Koonin, a registered
nurse and policy hand in the sprawling headquarters of the Centers for Disease
Control and Prevention in Atlanta, became a roving pandemic ambassador-without-portfolio
there, often directly at odds with the CDC’s terminally cautious and
ass-covering senior brass. Richard Hatchett was a New York emergency room
physician (who’d also been a patrician man of letters in his college days at
Vanderbilt); he landed in the ambit of Vice President Dick Cheney’s vast
national security empire-within-an-empire thanks to a blistering memo he drafted after pulling emergency duty at the Ground Zero site of the September
11 terror attacks. In that document, he called for the institution of a
permanent reserve medical corps. Carter Mecher, a senior medical administrator
in the Veterans Administration, did pioneering work to design fail-safe systems
to reduce the incidence of fatal medical error in intensive care units.The
origin story that launches the unlikely network of collaboration among these
far-flung policy entrepreneurs hinges on a random occurrence all but
tailor-made for a Michael Lewis narrative: In 2005, President George W. Bush,
still reeling from his administration’s obscenely incompetent handling of
Hurricane Katrina’s aftermath in New Orleans, sat down and read John Barry’s
chronicle of the lethal 1918 outbreak of the Spanish flu, The Great
Influenza: The Story of the Deadliest Pandemic in History. Bush realized
that the country had no effective plan in place to contain and overcome a
latter-day pandemic and so deputized Rajeev Venkayya, a physician then
detailed to head the Biodefense Directorate, deep in the bowels of the
recently launched Department of Homeland Security, to start putting one
together.In
turn, Venkayya assembled a team to assess the many harrowing risks created by a
pandemic outbreak and the most effective measures, absent a preexisting
vaccine, of containing its spread. At the center of this effort were Hatchett
and Mecher, who soon developed an intense odd-couple rapport on the job that is
also catnip to Lewis, as he crafts another wry-and-folksy account of how
otherwise bland and impersonal workplaces and institutional redoubts become
suddenly creative and counter-hierarchical: “Richard liked to borrow a phrase,
Carter a tool. Richard was top-down … Carter was bottom-up—there was no fact,
and no person, trivial enough to evade his curiosity. Richard left every classroom
he entered at or near the top; Carter often just left the classroom.” Together,
this band of intrepid misfits discovers a key plank of coherent pandemic
planning: that an early and aggressive campaign of social distancing can
effectively slow and contain a pandemic’s spread without a vaccine in play. In
the 1918 flu pandemic, for example, Philadelphia, which instituted such
measures just a week prior to the peak level of transmission, suffered twice
the number of fatalities that afflicted St. Louis, which managed to get
social distancing measures in place far earlier in the game. Mecher also
intuited early on that closing schools would probably be a crucial
time-and-life-saving device in a future pandemic: Children had a far greater number
of intimate, unstructured social encounters worked into their average days than
adults did, and those interactions looked to be prime breeding grounds for
future pandemic outbreaks. On
a parallel course, Bob Glass had sought to get the findings of his pandemic-modeling
experiments published in a scientific journal—not so much out of professional
vanity, since they didn’t really relate to his day-job duties at Sandia, but
because his immersion in the worst-case scenarios of pandemic transmission had
scared him shitless, which made publication feel like a public service to the
nation at large. Eventually, Hatchett and Mecher got wind of his work and set
about adapting his computer simulations to their own disaster
scenarios in the making. Again, the core teachings of the social distancing
gospel were confirmed—and thanks to Lisa Koonin’s dedicated missionary work in
Atlanta, the CDC itself was converted, albeit in its typically halting,
lumbering way. In time, the Bush White House’s ad hoc
pandemic task force could claim it had fulfilled its core mission, by getting
the federal public health colossus to start thinking differently, and more
inventively, about the sort of far-reaching prevention-minded social measures that
the new pandemic age mandated. When
the new planning model met its first real-world challenge—a 2009 outbreak of
swine flu, which evidently migrated north from Mexico—the federal response was
mixed. Mecher—the only member of the team who stayed on in the Obama years—had
Hatchett dispatched back to the White House to help navigate the new
administration’s health bureaucracy. The two men argued for a school shutdown in order to contain the spread of a new disease in its critical early phase, just
as their own pandemic playbook had counseled. But this time the CDC, ever-mindful of potential damage to its public image and chronically risk-averse,
dissented—and Obama and Education Secretary Arne Duncan eventually sided with
the CDC. As the crisis played out, it turned out that the new flu strain was
far less lethal than the White House planning corps originally reckoned—with
total American infections running somewhere between 40 and 80 million, 12,469 swine
flu patients died.The
less-grim-than-expected outcome of the swine flu scare doubtless helped supply
the rationale for the Trump White House’s now-notorious decision to shelve the
detailed and ambitious pandemic blueprint drafted and refined by the two prior
presidential administrations. And in 2018, when Trump’s newly hired national
security adviser John Bolton promptly fired homeland security adviser Tom
Bossert—a rare holdover from the George W. Bush years who’d endorsed the
Hatchett-Mecher plan and pledged to call on both men the instant a new pandemic
scare surfaced—the disease-prevention arm of the national security complex went
along with him. “Bolton redesigned the White House to focus on hostile foreign
countries rather than, say, national disasters and diseases,” Lewis writes.
“Bad people, rather than bad events.” In
this foreshortened landscape of risk, the world-historic bad event known as
Covid-19 took hold in early 2020, and the United States proved a fertile
breeding ground for the pandemic. The balance of The Premonition covers
the sickeningly familiar story of the nation’s descent into Covid paralysis and
mass death, as Lewis’s ragtag corps of formerly plugged-in pandemic fighters
tries, and mostly fails, to get a hearing at the senior levels of the
terminally feckless and paranoid Trump White House. “None of the people who had
been involved in the last fifteen years of thinking about pandemics were in the
conversation,” Bossert recalled. “They were deep state.” But unlike the deep
state of right-wing lore, these advisers were almost all on the outside of the
nexus of federal power, looking in, thanks to the myopic and disastrous
decision-making of the Trump White House.When
news of a new virus sweeping China broke, in January 2020, the old network of
Bush-era pandemic planners took to a running email thread to weigh the scale of
the risks ahead.When
news of a new virus sweeping China broke, in January 2020, the old network of
Bush-era pandemic planners took to a running email thread to weigh the scale of
the risks ahead and to workshop what an optimal federal response might be. (In
homage to their own maverick status and sensibility, they had dubbed themselves
“the Wolverines,” after the insurgent resistance forces in the 1980s movie
about a Soviet invasion of the U.S. So much, it seems, for the deep
state.) As the Covid speculations proliferated on the thread, the Wolverines gathered
new recruits along the way, including some panicked members of the Trump policy
world. (When the network started having weekly conference phone calls, Trump
administration figures would lurk silently in the background—until some hapless
physician and scientist found herself, without advance notice, speaking to,
say, Deputy Homeland Security Director Ken Cuccinelli.) Facing up to the epic
leadership and policy failures of the White House, the group decided to enlist
a senior state-level health official to advance an exemplary program of
comprehensive shutdowns and social distancing measures, per the original
pandemic playbook: Charity Dean, who’d been marooned in California’s highly
politicized and inertia-prone public health establishment, was clearly the woman
for the job. Like
Lewis’s other pandemic heroes, Dean is a stubbornly empirical, unsentimental
bureaucratic outsider, and a woman of swift and decisive action. An
introductory vignette about her tenure in Santa Barbara has her cutting open
the chest of a woman who’d recently died of tuberculosis with a pair of gardening shears
on a picnic table, after the local coroner refused to extract his own sample
from the cadaver’s lungs to determine how far the infection had spread. After
newly elected California Governor Gavin Newsom passed her over in 2019 for her
expected promotion to lead the state public health administration, Dean
developed a strong foreboding that a major health crisis was coming. (It’s this
episode that apparently furnishes the book’s title; Lewis reports that Dean
“felt this premonition. It resembled the feeling she sometimes had at the start
of an outbreak back in Santa Barbara County.”) And in early 2020, as she grew
more vocal about the imminent, deadly risks of Covid-19, she was routinely exiled
from upper-level confabs about the state’s still-evolving Covid containment
strategies. She was, in short, an eager recruit to the Hatchett-Mecher team, eventually
conscripted by them to draft an alternate Covid containment plan not only for
California but for the country at large, in the glaring absence of any
such initiative from the expected channels of federal power.Her
draft plan was a social distancing regimen, heavily reliant on data-savvy
tracking applications that would indicate when residents of a given zip code
had graduated out of a stringent lockdown regime into a moderately looser one.
The model she had in mind, like that of many of Lewis’s pandemic heroes, was a
mobilization of collective will and self-sacrifice of the sort that one normally
sees in wartime. As she neared the end of her draft plan, she exhorted
Americans “to rise collectively in the spirit of patriotism with the same vigor
and stubborn resolve that our grandparents’ generation rose to meet the moment
of WW2.” In this scheme of things, she later explained to Lewis, “government
has a role, but its role is to empower the grass roots by giving them data.”The
trouble here is not so much that California and the nation bypassed many of Dean’s
recommendations in favor of a far more shambolic and erratic response to the
Covid epidemic; rather, it’s that this eminently sound model of pandemic health
care can get no meaningful traction in our country’s patchwork, profit-driven,
and unequal system of health care provision. Like other ideal-type presumptions
of liberal policy wonkery—such as the notion that education alone is the
all-purpose engine of upward social mobility—it presumes an efficient and
equitable system of access where nothing remotely close to such a thing exists.
That’s why the countries that have achieved exemplary success in Covid
containment, such as Taiwan, have been able to test, track, and vaccinate via a
single-payer model of universal health coverage. (Taiwan also has taken strict
measures to ensure that all the social data the government collects to track
the spread of Covid is destroyed within 28 days—a basic civic precaution that
is again unimaginable in America’s proprietary system of surveillance
capitalism, jointly administered by government and tech monopolies.) In other
words, for Dean’s grassroots model of Covid tracking and testing to work, an
entirely different system of health care—together with a trustworthy and
transparent system of government oversight—would need to be in place first.Nor
is it the case that the experience of the Covid lockdown has unambiguously
borne out the counsel of the Hatchett-Mecher team. Even after California
adopted a good portion of Charity Dean’s action plan, via an emergency task
force appointed by Newsom, with an accelerated testing-and-tracing regime, the
results were equivocal over the longer term. At the time—the early spring of
2020—the California plan was “a triumph,” Lewis writes. Paul Markovich, CEO of Blue
Shield of California, who joined Dean and venture capitalist Bob Kocher on the
task force, remarked that “I don’t think we repelled aliens who were trying to
invade the earth, but it kind of felt like it.” Now, however, California, like
the rest of the country, is racing to get enough of its residents vaccinated to
reach something close to herd immunity before a
deadly fourth Covid wave
crashes across the state.None
of this is to discredit the genuinely brave and heroic efforts of Dean,
Hatchett, Mecher, and the other policy entrepreneurs in the bureaucratic
morality play of The Premonition; science is by definition an
experimental, provisional, trial-and-error endeavor, and it’s to be expected
that the apostles of scientific inquiry will make mistakes and miscalculations,
and correct subsequent plans and models accordingly. But it is to question
whether the moral of Lewis’s science-triumphing-over-politics set piece is as
pat and tidy as Lewis makes it seem. For one thing, the federal health
bureaucracy is almost exclusively represented in the pages of Lewis’s book by
the CDC—even though the agency played no role in drafting the Bush-era pandemic
strategy. (That said, of course, the CDC’s forays into policy during the early
days of the Covid pandemic were indeed exasperatingly confused, contradictory, and harmful, as anyone who remembers its senseless early
resistance to mask-wearing can
readily confirm.)In a
book seeking to lay bare the government myopia that’s thwarted the effective
adoption of pandemic prevention measures, it’s exceedingly strange that Dr.
Anthony Fauci, head of the U.S. National Institute of Allergy and Infectious
Diseases, and the culture hero of many liberal detractors of the Trumpian
mishandling of the Covid crisis, merits but a single passing cameo appearance.
Deborah Birx, the Trump administration’s decidedly more compromised—but still
undeniably influential—White House coronavirus-response coordinator, doesn’t
rate a mention at all. Even the signature villains of the hideously botched
Trump Covid initiative—Vice President Mike Pence and presidential son-in-law
Jared Kushner—barely put in an appearance, while Trump himself, with his surreal
press conference diagnostics and crackpot racist outbursts about the pandemic’s
origins, is a remote and muffled presence, the policy equivalent of the
madwoman in the attic in a Victorian gothic romance.The
main action, Lewis insists throughout, concerns the efforts of the insurgent
pandemic policy entrepreneurs to gain the attention and interest of the hidebound,
risk-averse, and image-conscious CDC, pursuing its own terminally opaque
institutional agenda down in Atlanta. It’s an account of an account of what is
at bottom a political power struggle—over how to redefine public health, how to
assess society-wide risk, how to deliver equitable as well as briskly provided
health care resources and treatment—with much of the actual politics written
out of the picture.It’s
not hard to surmise the thinking behind this narrative choice. Without the
messy and chaotic battle for power and influence both within the Trump White
House and on the broader public health bureaucracy, The Premonition can
deliver the same blandly reassuring moral that The Fifth Risk and Moneyball
did: With a bold embrace of more innovative and data-driven fixes, the public
health bureaucracy, like the civil service and the twenty-first-century model of
baseball management, can play the starring role in an edifying parable of
efficiency. Like those studies, The Premonition evokes a fundamentally
frictionless world of nimbly-executed solutionism—a vision of a perennially
improving civitas produced by just the right complement of innovative
disruption, planning protocols, and data inputs. In his introduction, Lewis
writes, “I think this particular story is about the curious talents of a
society, and how those talents are wasted if not led.”Sure
enough, Lewis preaches on the plague of public-sector stodginess and
inefficiency throughout The Premonition. Again and again, his dramatis
personae report that they’re “mystified” by the federal government’s flagrant
misallocation of resources and talent, noting “in particular the way some
people were able to use their own inefficiency to create a seeming need for
more funding.” True, the brutal logic of market-driven health care has produced
plenty a perverse incentive of its own, erecting “a U.S. medical-industrial
complex that lurched between lethargy and avarice”—but at least these excesses,
in Lewis’s telling, are theoretically remediable via the networks of
meritocratic savvy he sees on the ascendant. Government dysfunction, by
contrast, is deep-seated and congenital, as he argues when he contrasts the
Hatchett-Mecher crusade with the Moneyball
revolution: “The market forces that punish ignorance were far more intense in
pro sports than they were in disease control; the mistakes made by
epidemiologists didn’t cause their teams to lose and their bosses to waste tens
of millions of dollars.”“Then when I said, ‘We’re going to do
private government operations, like Blackwater,’ their eyes lit up and they
said, ‘Oh wow, you could take over the world.’” Leaving
aside the obvious bankruptcy of this comparison—not only are the real-world
stakes of epidemiology-related error far higher than the embarrassment of a
losing season, but pro sports owners are absurdly insulated from actual “market
forces,” as Major League Baseball’s century-old antitrust exemption, and no end
of municipal stadium tax breaks, make all too clear—there’s a universe of
ahistorical presumption lurking just beyond the scope of this little market
parable. Some of the most devastating debacles of modern American
governance—from the Vietnam War to the savings and loan meltdown to the 2003
invasion of Iraq to the 2008 financial collapse—occurred at the behest of just
the sort of executive-level knowledge elites that Lewis lionizes in the pages of
The Premonition. To contend that yet another corps of strategically
placed, data-savvy technocrats holds the key to our collective salvation is to
disregard the bulk of modern American political history.The
Premonition isn’t detained by any
such downbeat reflections as it cruises to what feels like its inevitable
climax. Even after her boss at the California Department of Public Health was finally forced to decamp, and Charity Dean was all but assured that
she’d take the reins, she elects to bail out of government work entirely. “Once
she’d become a public-health officer,” Lewis writes,she’d imagined an entire career in public service. Now
she did not believe that the American government, at this moment in its history,
would ever do what needed doing.… From the point of view of American culture,
the trouble with disease prevention was that there was no money in it. She
needed to find a way to make it pay. So
she does. A year into the pandemic, she founds something called the Public
Health Company, bankrolled by a venture capitalist named Todd Park, who’d
worked as chief technology officer in the Obama White House, who now captains a
major billing fiefdom in the vast empire of for-profit health care. At first,
Dean reports, it was awkward to interest prospective investors in the selling
points of a health care startup seeking to render the myriad dysfunctions of
our public health infrastructure somewhat workable again. “Five smart people
have replied with confusion when I said the company was to save the world and
protect our country,” Dean recalled. “Then when I said, ‘We’re going to do
private government operations, like Blackwater,’ their eyes lit up and they
said, ‘Oh wow, you could take over the world.’” Again,
a glum, politically minded naysayer might well have pointed out that the
Blackwater model of taking over the world involves an ugly combination of
indifferently punished war
crimes, mercenary domestic
spying, and rampant plutocratic corruption and fraud. But why spoil the stirring spectacle of human talent
being properly led, at long last? Charity Dean is playing Moneyball, and all is
right in Michael Lewis’s world.
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